Home Health & Hospice Week

Plus: If it hasn’t yet, your turn will come.

If you’re not passing the Probe & Educate medical reviews of your records, you may not have to worry about it too much longer.

In instructions for the campaign that examines five claims from every home health agency nationwide, the Centers for Medicare & Medicaid Services has indicated that HHAs that have two or more claims identified with problems will go back in the P&E review cycle for another round of P&E review.

Question: “If a second round of probe and educate Additional Development Requests (ADRs) is conducted, and you don't fare well in the second round, will there be an additional round of Probe & Educate ADRs?” asked one agency in Palmetto GBA’s March 16 Ask the Contractor Teleconference.

Answer: “There has been no information provided that would allow for more than two rounds of Probe & Educate ADRs,” the HHH Medicare Administrative Contractor responds in a questionand-answer set from the ACT.

However, don’t be surprised to see CMS continue the campaign, even if it’s in another form, due to the sky-high denial rates it’s producing, industry veterans say.

On the other hand, if you haven’t had any claims reviewed under P&E yet, don’t expect that to last. “All home health agencies who submit claims for Medicare home health services will be included in the Probe & Educate program,” Palmetto responded to another question. “The claims are not pulled in any specific order, so it may take some time for all providers to see ADRs for Probe & Educate. Please be patient as the process moves along.”